Herpetic keratitis: diagnosis and treatment
Last reviewed: 23.04.2024
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Diagnosis of herpetic keratitis
Diagnosis of herpetic keratitis is based mainly on a typical clinical picture of the disease. Part of the characteristic signs are detected already at the beginning of the disease, for example, bubble, tree-like rashes, a decrease in sensitivity, a connection with the common cold and herpetic foci of inflammation on other parts of the body. Some features of the clinical picture are too late: the absence of neovascularization for a long period of time, a prolonged course of the inflammatory process, a tendency to relapse. In this regard, for atypical flow of keratitis, laboratory methods of diagnosis are used. For the study, scraping of the epithelium of the conjunctiva and the cornea, as well as a lacrimal fluid, is taken. The most informative and fastest in execution is the technique for detecting fluorescent antibodies. Intradermal test with anti-herpetic vaccine is performed only at the initial meeting with the virus. Focal allergic test with antiherpetic vaccine is an important method of etiological diagnosis in atypical cases. This provocative test is considered positive if, in response to intradermal administration of the vaccine in weak dilutions, the inflammation aggravates, pain and pericorneal injection of the vessels increase, fresh precipitates appear. Diagnostic tests are performed with caution according to strict indications.
[Treatment of herpetic keratitis
Treatment of herpetic keratitis is complex and lasting. It is aimed at suppressing the vital activity of the virus, improving trophic processes in the cornea, accelerating the epithelialization of defects, increasing local and general immunity.
Antiviral treatment includes chemotherapy, nonspecific and specific immunotherapy. In the different stages of the disease, the appropriate combination of drugs is used. At the beginning of the disease, daily frequent kerecid instillation, deoxyribonuclease, lay ointments with tebrofen, florenalum, bonaflot, oxolin, zovirax 3-4 times a day. Every 5-10 days drugs are changed. Acyclovir is taken orally for 10 days. If the eye disease is combined with a herpetic inflammation of another localization, the duration of the course of treatment is increased to 1-2 months. In the case of severe complications, intravenous infusions of acyclovir are administered every 8 hours for 3-5 days. It is a highly active drug, but it has a narrow spectrum of action, so it is used against simple and herpes simplex viruses.
Along with chemotherapy drugs are used for non-specific antiviral action - interferon in droplets and subconjunctival, as well as drugs that stimulate the production of endogenous interferon (interferonogens) that prevent the virus from multiplying in the cell, - half-dose (course dose - 2000 ED), pyrogenal in pyrogen-free doses, prodigiosan ( 3-5 intramuscular injections). With a decrease in immunity, the chronic and recurrent course of the disease is prescribed immunostimulants - levamisole, thymalin. For specific immunotherapy, human immunoglobulin and anti-herpes vaccine are used.
For the treatment of various forms of keratitis, the optimal combinations of antiviral agents and the regimens for their use have been developed.
To clean ulcer surfaces from necrotic masses, a cryoprobe or laser coagulation is used. With long-term non-healing herpetic keratitis, a corneal transplant is performed with a therapeutic purpose.
In cases where bacterial flora is attached, additionally prescribe sulfanilamide preparations, antibiotics, non-steroidal anti-inflammatory drugs in the form of drops and ointments. For the prevention and treatment of concomitant irites and iridocyclitis, mydriatica are used.
In addition to the main antiviral treatment, prescribe vitamins and drugs that improve the trophicity of the cornea, as well as if necessary, antiallergic drugs.
Corticosteroids are used with great caution only at the stage of regression with deep stromal keratitis, under the constant control of the state of the corneal epithelium and intraocular pressure, as they can complicate the course of herpetic keratitis, and in the interictal period promote the occurrence of relapses due to a pronounced immunosuppressive effect.
After the end of the anti-inflammatory and symptomatic treatment of keratitis, when the eye completely calms down, a restorative treatment is required - corneal transplantation with an optical purpose.